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Tako-Tsubo CardiomyopathyTime of Onset of Tako-Tsubo Cardiomyopathy: Is a Temporal Pattern of Onset Confirmed? FREE TO VIEW

Roberto Manfredini, MD; Eduardo Bossone, MD, FCCP; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy
Author and Funding Information

From the Clinica Medica, Department of Clinical and Experimental Medicine and Vascular Diseases Center (Dr Manfredini), University of Ferrara; and the Cardiology Division (Dr Bossone), Amalfi Coast Hospital.

Correspondence to: Roberto Manfredini, MD, Clinica Medica, Department of Clinical and Experimental Medicine and Vascular Diseases Center, Via Savonarola 9, 44100 Ferrara, Italy; e-mail: roberto.manfredini@unife.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1101. doi:10.1378/chest.11-1022
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To the Editor:

In a recent issue of CHEST (April 2011), Parodi et al1 presented interesting results about recurrence and long-term mortality in a prospective cohort of 116 patients with tako-tsubo cardiomyopathy (TTC) observed in five hospitals of the urban area of Tuscany, Italy. This cohort of patients, together with that of the Tako-Tsubo Italian Network (n = 112 at the update of December 31, 2009) probably represents the largest population of patients with TTC ever reported in literature. After our first reports of a temporal variation in the onset of TTC, characterized by seasonal (summer), circadian (morning), and weekly (Monday) patterns of onset,2,3 we performed a computer-assisted search of the literature (years 2000-2010) to verify whether the temporal occurrence of TTC has been studied by other investigators around the world.4 We focused on studies with a minimum of numbers to allow statistical analysis and found 19 studies with ≥ 30 cases. Of these, only seven (four from Europe and one each from Asia, Australia, and the United States; total number of cases: 391) included in the time of onset of events and confirmed preferential peaks during summer months and morning hours.4 Of course, the limited number of patients considered in these studies does not allow us to draw definite conclusions, and the time of onset cannot be a useful tool in making a differential diagnosis between myocardial infarction and TTC.5 However, should particular temporal frames of higher risk be confirmed in larger populations, this could help to ensure adequate pharmacologic protection during vulnerable periods (eg, tailored use of β-blockers in subjects at potential risk). Based on the number of cases reported by Parodi et al1 and also considering that the observation period (July 2003-March 2008) limits the possibility of a seasonal analysis (complete years are required), it could be very interesting to verify whether temporal patterns of onset are observed also in the Tuscany Registry.

Parodi G, Bellandi B, Del Pace S, et al; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy for the Tuscany Registry of Tako-Tsubo Cardiomyopathy Natural history of tako-tsubo cardiomyopathy. Chest. 2011;1394:887-892 [CrossRef] [PubMed]
 
Citro R, Previtali M, Bovelli D, et al. Chronobiological patterns of onset of tako-tsubo cardiomyopathy: a multicenter Italian study. J Am Coll Cardiol. 2009;542:180-181 [CrossRef] [PubMed]
 
Manfredini R, Citro R, Previtali M, et al; Takotsubo Italian Network investigators Takotsubo Italian Network investigators Monday preference in onset of takotsubo cardiomyopathy. Am J Emerg Med. 2010;286:715-719 [CrossRef] [PubMed]
 
Bossone E, Citro R, Eagle KA, Manfredini R. Tako-tsubo cardiomyopathy: is there a preferred time of onset? Int Emerg Med. 2011;63:221-226 [CrossRef]
 
Manfredini R, Eagle KA, Bossone E. Acute myocardial infarction and tako-tsubo cardiomyopathy: Could time of onset help to diagnose? Expert Rev Cardiovasc Ther. 2011;92:123-126 [CrossRef] [PubMed]
 

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References

Parodi G, Bellandi B, Del Pace S, et al; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy for the Tuscany Registry of Tako-Tsubo Cardiomyopathy Natural history of tako-tsubo cardiomyopathy. Chest. 2011;1394:887-892 [CrossRef] [PubMed]
 
Citro R, Previtali M, Bovelli D, et al. Chronobiological patterns of onset of tako-tsubo cardiomyopathy: a multicenter Italian study. J Am Coll Cardiol. 2009;542:180-181 [CrossRef] [PubMed]
 
Manfredini R, Citro R, Previtali M, et al; Takotsubo Italian Network investigators Takotsubo Italian Network investigators Monday preference in onset of takotsubo cardiomyopathy. Am J Emerg Med. 2010;286:715-719 [CrossRef] [PubMed]
 
Bossone E, Citro R, Eagle KA, Manfredini R. Tako-tsubo cardiomyopathy: is there a preferred time of onset? Int Emerg Med. 2011;63:221-226 [CrossRef]
 
Manfredini R, Eagle KA, Bossone E. Acute myocardial infarction and tako-tsubo cardiomyopathy: Could time of onset help to diagnose? Expert Rev Cardiovasc Ther. 2011;92:123-126 [CrossRef] [PubMed]
 
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